Man With Vision Loss and Eye Pain

Abstract

A 51-year-old man presented to the emergency department, complaining of vision loss and ocular pain 10 days after he received vitrectomy for nonclearing vitreous hemorrhage in his left eye. On ophthalmology consultation, his visual acuity was hand motions and intraocular pressure was 40 mm Hg in the left eye. Slit-lamp biomicroscopic examination (Figure 1) and ocular ultrasonography (Figure 2) were conducted. Aqueous humor and vitreous cultures were performed.Figure 2Ocular ultrasonographic image showing an ovoid lesion (asterisk) with moderate internal reflectivity.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Phacoantigenic uveitis (phacoanaphylactic endophthalmitis) with glaucoma and dislocated lens. Slit-lamp biomicroscopic examination (Figure 1) showed ciliary congestion, corneal edema, and fluffy lenticular materials (white arrow) on the top of blood-tinged hypopyon (black arrow). Ocular ultrasonography (Figure 2) revealed vitreous opacity and dislocated lens (asterisk). Pars plana vitrectomy and lensectomy were performed. During the surgery, the dislocated lens was identified in the vitreous cavity, without obvious signs of infectious endophthalmitis. No growth of organisms was identified in vitreous and aqueous samples. Three months after surgery, his final vision was 4/200 because of myopic maculopathy. Phacoantigenic uveitis typically develops 1 to 14 days after traumatic or surgical perforation of the lens capsule and is characterized by a granulomatous antigenic reaction to lens protein.1Marak Jr., G.E. Phacoanaphylactic endophthalmitis.Surv Ophthalmol. 1992; 36: 325-339Abstract Full Text PDF PubMed Scopus (56) Google Scholar Clinically, phacoantigenic uveitis can be difficult to distinguish from other forms of postoperative uveitis or endophthalmitis. Findings can range from mild anterior uveitis to fulminant endophthalmitis with hypopyon. Initial therapy is to control the intraocular pressure with intraocular pressure-decreasing medications and to reduce the inflammation with topical steroids. When phacoantigenic uveitis follows lens trauma, as with our patient, surgery is required for definitive treatment.